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General NPI Number Information
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NPI Number | 1437303948
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Entity Type | Organization
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Legal Business Name | GREG A MCCLURG
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 10721 CHAPMAN HWY SUITE 5
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City | SEYMOUR
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State | TN
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Zip | 37865-4765
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Country | US
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Telephone | 865-577-6650
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Fax | 865-577-0452
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Provider Business Mailing Address
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Address Line | 10721 CHAPMAN HWY SUITE 5
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City | SEYMOUR
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State | TN
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Zip | 37865-4765
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Country | US
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Telephone | 865-577-6650
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Fax | 865-577-0452
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. GREG A MCCLURG
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Credential | O.D.
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Telephone | 865-577-6650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | ODT1631
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License Number State | TN
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